When a COVID-19 vaccine becomes available, who will be first in line? According to an “ Interim Playbook for Jurisdiction Operations ” published by the Centers for Disease Control and Prevention (CDC) in October, the Departments of Defense (DoD) and State, the Veterans Health Administration (VHA), Indian Health Services, and Bureau of Prisons will all receive a direct allocation, but the distribution of those allocations will depend on the outcomes of an elaborately branched decision tree.
Although the DoD will distribute the vaccine directly to all of its personnel, including retirees and dependents, the plan for members of the Reserve and National Guard is not yet clear. Employees at VHA facilities will receive the vaccine from their departments. The US Department of Veterans Affairs (VA) has announced a “limited-supply phase” for distribution followed by a “general implementation phase.”
The CDC will provide the vaccine to tribal nations that have selected the IHS for distribution (as opposed to the state). According to Government Executive , a separate internal IHS plan suggests the agency would distribute immunizations to tens of thousands of health care and other essential workers, but it isn’t known whether that number includes all of the agency’s workers.
The VA is likely to receive the largest distribution of vaccine doses, according to internal documents obtained by Government Executive . The agency has said it will only finalize its vaccine strategy after a candidate is approved for use. In a Nov. 17 press release, the VA said, “The plan will be a phased approach based on scientific and historical evidence, lessons learned from past pandemic vaccine plans and input from scientific experts both within and outside VA.”
However, the VA has been criticized for not publicizing a detailed vaccine distribution plan. Several Democrats on the Senate Committee on Veterans’ Affairs, for instance, sent a cautionary letter to VA leaders on Nov. 23, saying, “For COVID-19 vaccine distribution to succeed there must be a well-organized plan to meet the needs of all veterans and their providers…. If the states and other federal agencies have already publicly released their plans, why is VA lagging behind?”
As with most federal and non-federal entities, the VA’s allotment of vaccine will be distributed in phases, based on availability and the number of those in the highest-risk populations, such as frontline health care workers and the elderly, within the organization. But the distribution strategy resembles a set of matryoshka dolls, with priorities nested within priorities.
Staff will be 4 of the first 5 populations to receive the vaccine. Employees at VA nursing homes and the 25 Spinal Cord Injuries and Disorders Centers also are due to receive the first batch, followed by veterans at those facilities. Next would come staff in emergency departments, COVID-19 ICUs, and COVID-19 non-ICUs. After that, employees in “other congregate living settings” and veterans aged > 85 years would be vaccinated. Other employees critical in the COVID-19 response, such as police, would be next, followed by inpatient staff in other units and staff performing high-risk procedures. Finally, the priorities will be other groups of patients, veterans in other descending-age groups, and homeless veterans and homeless outreach workers.
The general thinking is that it makes more sense to vaccinate the health care workers first. However, even within that calculation there are further decisions to make. The VA has said it’s focusing on the highest-risk individuals for the first inoculations, but it has emphasized that it considers the risk of transmitting the virus to others above the personal risk of severe illness to the employees themselves.
The VA will not require employees to receive an inoculation, although it plans to encourage staff to do so to protect themselves and veterans they serve.